Vaginal lactoferrin in prevention of preterm birth in women with bacterial vaginosis

Objective: To evaluate use of vaginal lactoferrin in prevention of preterm birth (PTB) in women with first trimester bacterial vaginosis and prior spontaneous PTB.Methods: This is a retrospective cohort study of all consecutive singleton gestations with prior PTB, and first trimester diagnosis of bacterial vaginosis. Women who were found to have bacterial vaginosis were recommended lactoferrin 300 mg vaginal tablets daily for 21 days. The primary outcome was the incidence of PTB at less than 37 weeks of gestations. Outcomes were compared in women who received daily lactoferrin with those who did notResults: During the study period, 847 pregnant women with prior spontaneous PTB were screened for bacterial vaginosis. Of them, 193 were found to have bacterial vaginosis in the first trimester, with an overall incidence of 22.8%. Out of the 193 women, 125 met the inclusion criteria for the study and were analyzed. Sixty of the included women received vaginal lactoferrin, while 65 did not. Women who received supplementation with lactoferrin had a significantly lower rate of PTB < 37 weeks (25.0 versus 44.6%; p = .02), lower mean gestational age at delivery (37.7 ± 3.2 versus 35.9 ± 4.1 weeks; p = .01), and lower rate of admission for threatened PTL (45.0 versus 70.8%; p = .04). No between-group differences were noticed in the other outcomes, including chorioamnionitis, PPROM < 34 weeks, and neonatal outcomes. No cases of late miscarriage were reported in our cohort. No cases of adverse events were reported.Conclusion: Based on this small single-center retrospective study, supplementation with vaginal lactoferrin in women with first trimester bacterial vaginosis may be an option to reduce the risk of preterm delivery

The prevalence of pancreatic cystic lesions in patients with liver cirrhosis is double that in controls

Background and aims: Pancreatic cystic lesions (PCLs) are commonly diagnosed incidentally and are often preneoplastic. Their presence may influence the management of patients with chronic diseases such as liver cirrhosis (LC). This study evaluated the prevalence and nature of PCLs in LC patients. Methods: The images of 192 LC patients and 192 controls who underwent either computed tomography scan or nuclear magnetic resonance were reviewed for the presence and nature of PCLs. The prevalence of PCLs in both groups and differences between LC patients with and without PCLs were analysed. Multiple logistic regression analysis was used to investigate factors associated with PCLs. Results: Thirty-five of 192 LC patients (18%) and 19/192 controls (10%) had PCLs (p =.027). The prevalence of presumptive intraductal pancreatic mucinous neoplasm (IPMN) was double in LC patients compared with controls (14% vs 7%; p =.065). In multivariate analysis, age, LC and having undergone a magnetic resonance cholangiopancreatography were factors associated with PCLs and IPMNs. LC patients with PCLs were older at the time of imaging and had a longer history of liver disease (67 vs. 43 months; p = 0.039) compared with LC patients without PCLs. Conclusions: PCLs are more common in LC patients than in controls, and most are IPMNs. The occurrence of PCLs in LC patients seems to be related to age and disease duration

How good are low back pain guidelines? A critical appraisal of the quality of clinical practice guidelines using the agree II tool

Clinical practice guidelines (CPGs) provide evidence-based recommendations for clinical practice, but their increasing number in the last few years arises possible concerns about their quality. Preliminary results on the methodological quality of CPGs for low back pain management (LBP) are here presented. The results of this review can help researchers and Italian policymakers select and adopt the highest quality Clinical Practice Guidelines (CPGs) for Low Back Pain (LBP) management in the CPG National Systems (Sistema Nazionale Linee Guida)

Sarcopenia is associated with reduced survival in patients with advanced hepatocellular carcinoma undergoing sorafenib treatment

Background: Sarcopenia has been associated with poor outcomes in patients with cirrhosis and solid tumours. Objective: Analyse the influence of sarcopenia on survival and treatment duration in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib. Methods: We conducted a multicentre, retrospective study on 96 patients with advanced HCC treated with sorafenib, all with available abdominal computed tomography (CT) scan within 30 days from treatment start. Anthropometric, laboratory, treatment and follow-up data were collected. Sarcopenia was defined by reduced skeletal muscle index calculated from an L3 section CT image. Results: Sarcopenia was present in 49% of patients. Patients were divided into two groups according to sarcopenia: age was significantly higher in the sarcopenic group (SG) (66 years (31–87) versus 72 years (30–84), p = 0.04], with no difference in other baseline characteristics. The SG showed shorter overall survival (OS) (39 (95% confidence interval (CI) 26–50) versus 61 (95% CI 47–77) weeks (p = 0,01)) and shorter time on treatment (12.3 (95% CI 8–19) versus 25.9 (95% CI 15–33) weeks (p = 0.0044)). At multivariate analysis, sarcopenia was independently associated to reduced OS (p = 0.03) and reduced time on treatment (p = 0.001). Conclusion: Sarcopenia is present in almost half of patients with advanced HCC, and is associated with reduced survival and reduced duration of oral chemotherapy

Magnetic resonance of rectal cancer response to therapy: an Image quality comparison between 3.0 and 1.5 Tesla

Purpose. To evaluate signal intensity (SI) differences between 3.0 T and 1.5 T on T2-weighted (T2w), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) in rectal cancer pre-, during, and postneoadjuvant chemoradiotherapy (CRT). Materials and Methods. 22 patients with locally advanced rectal cancer were prospectively enrolled. All patients underwent T2w, DWI, and ADC pre-, during, and post-CRT on both 3.0 T MRI and 1.5 T MRI. A radiologist drew regions of interest (ROIs) of the tumor and obturator internus muscle on the selected slice to evaluate SI and relative SI (rSI). Additionally, a subanalysis evaluating the SI before and after-CRT (ΔSI pre-post) in complete responder patients (CR) and nonresponder patients (NR) on T2w, DWI, and ADC was performed. Results. Significant differences were observed for T2w and DWI on 3.0 T MRI compared to 1.5 T MRI pre-, during, and post-CRT (all P&lt;0.001), whereas no significant differences were reported for ADC among all controls (all P&gt;0.05). rSI showed no significant differences in all the examinations for all sequences (all P&gt;0.05). ΔSI showed significant differences between 3.0 T and 1.5 T MRI for DWI-ΔSI in CR and NR (188.39±166.90 vs. 30.45±21.73 and 169.70±121.87 vs. 22.00±31.29, respectively, all P 0.02) and ADC-ΔSI for CR (-0.58±0.27 vs. -0.21±0.24P value 0.02), while no significant differences were observed for ADC-ΔSI in NR and both CR and NR for T2w-ΔSI. Conclusion. T2w-SI and DWI-SI showed significant differences for 3.0 T compared to 1.5 T in all three controls, while ADCSI showed no significant differences in all three controls on both field strengths. rSI was comparable for 3.0 T and 1.5 T MRI in rectal cancer patients; therefore, rectal cancer patients can be assessed both at 3.0 T MRI and 1.5 T MRI. However, a significant DWI-ΔSI and ADC-ΔSI on 3.0 T in CR might be interpreted as a better visual assessment in discriminating response to therapy compared to 1.5 T. Further investigations should be performed to confirm future possible clinical application

Optimization of contrast medium volume for abdominal CT in oncologic patients: prospective comparison between fixed and lean body weight-adapted dosing protocols

Background: Patient body size represents the main determinant of parenchymal enhancement and by adjusting the contrast media (CM) dose to patient weight may be a more appropriate approach to avoid a patient over dosage of CM. To compare the performance of fixed-dose and lean body weight (LBW)-adapted contrast media dosing protocols, in terms of image quality and parenchymal enhancement. Results: One-hundred cancer patients undergoing multiphasic abdominal CT were prospectively enrolled in this multicentric study and randomly divided in two groups: patients in fixed-dose group (n = 50) received 120&nbsp;mL of CM while in LBW group (n = 50) the amount of CM was computed according to the patient’s LBW. LBW protocol group received a significantly lower amount of CM (103.47 ± 17.65&nbsp;mL vs. 120.00 ± 0.00&nbsp;mL, p &lt; 0.001). Arterial kidney signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) and pancreatic CNR were significantly higher in LBW group (all p ≤ 0.004). LBW group provided significantly higher arterial liver, kidney, and pancreatic contrast enhancement index (CEI) and portal venous phase kidney CEI (all p ≤ 0.002). Significantly lower portal vein SNR and CNR were observed in LBW-Group (all p ≤ 0.020). Conclusions: LBW-adapted CM administration for abdominal CT reduces the volume of injected CM and improves both image quality and parenchymal enhancement

Cochrane rehabilitation: 2020 Annual report

during its fourth year of existence, cochrane rehabilitation went on to promote evidence-informed health decision-making in rehabilitation. in 2020, the outbreak of the coVid-19 pandemic has made it necessary to alter priorities. in these challenging times, cochrane rehabilitation has firstly changed its internal organisation and established a new relevant project in line with pandemic needs: the REH-COVER (Rehabilitation – coVid-19 evidence-based response) action. the aim was to focus on the timely collection, review and dissemination of summarised and synthesised evidence relating to COVID-19 and rehabilitation. Cochrane Rehabilitation REH-COVER action has included in 2020 five main initiatives: 1) rapid living systematic reviews on rehabilitation and coVid-19; 2) interactive living evidence map on rehabilitation and coVid-19; 3) definition of the research topics on “rehabilitation and COVID-19” in collaboration with the World Health Organization (WHO) rehabilitation programme; 4) Cochrane Library special collection on Coronavirus (COVID-19) rehabilitation; and 5) collaboration with COVID-END for the topics “rehabilitation” and “disability.” Furthermore, we are still carrying on five different special projects: Be4rehab; RCTRACK; definition of rehabilitation for research purposes; ebook project; and a prioritization exercise for Cochrane Reviews production. The Review Working Area continued to identify and “tag” the rehabilitation-relevant reviews published in the cochrane library; the publication Working area went on to publish Cochrane Corners, working more closely with the Cochrane Review Groups (CRGs) and Cochrane Networks, particularly with Cochrane Musculoskeletal, oral, skin and sensory Network; the Education Working area, the most damaged in 2020, tried to continue performing educational activities such as workshops in different online meetings; the Methodology Working area organized the third and fourth cochrane Rehabilitation Methodological (CRM) meetings respectively in Milan and Orlando; the Communication Working Area spread rehabilitation evidences through different channels and translated the contents in different languages

Insights on the climatic evolution at the pre-Jaramillo to Jaramillo transition in Europe using mineralogical analysis of the Quibas palaeontological site (Early Pleistocene, southern Iberian Peninsula)

© The Authors, 2023. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (for details please see http://creativecommons.org/licenses/by/4.0/), which permits use, copy, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source. This document is the Published version of a Published Work that appeared in final form in Spanish Journal of Palaeontology. To access the final edited and published work see https://doi.org/10.7203/sjp.27562The palaeontological site of Quibas is a karst outcrop with an age between 1.1 and 0.9 Ma (late Early Pleistocene). It represents the unique continuous sequence of terrestrial vertebrates of pre-Jaramillo to Jaramillo age in Europe. It is formed by two main structures: Quibas-Sima (divided into units QS-1 to QS-7) and Quibas-Cueva (QC-1– QC-6). In this work, we analyse the mineralogical composition of the sediments that form the stratigraphic units of Quibas-Sima using X-ray diffraction analysis, electrical conductivity, ion chromatography and optical emission spectrometry, to evaluate climatic trends in the sequence. Preliminary results indicate that there is an increase in the proportions of carbonates, gypsum and halite from QS-2 towards QS-4 and QS-5 (1.07–0.99 Ma), suggesting a progressive decrease in precipitation in south-eastern Iberian Peninsula a million years ago. Our data are consistent with the onset of a glacial phase, which is supported by the progressive disappearance of taxa related to forests and water bodies in Quibas-Sima, such as the flying squirrel Hylopetes sp. and the semiaquatic shrew Neomys sp., in favour of the appearance of taxa linked to open areas such as the Montpellier snake (Malpolon monspessulanus) and the snub-nosed viper (Vipera latastei). El yacimiento paleontológico de Quibas es un afloramiento kárstico con una edad comprendida entre 1,1 y 0,9 Ma (Pleistoceno Inferior tardío). Representa la única secuencia continua de vertebrados terrestres de edad pre-Jaramillo a Jaramillo de Europa. Está formado por dos estructuras principales: Quibas-Sima (dividida en las unidades QS-1 a QS-7) y Quibas-Cueva (QC-1 a QC-6). En este trabajo se estudia la composición mineralógica de los sedimentos que conforman las unidades estratigráficas de QuibasSima, a través e análisis de difracción de rayos X, conductividad eléctrica, cromatografía iónica y espectrometría de emisión óptica por plasma de argón, con el objetivo de evaluar tendencias paleoclimáticas en la secuencia. Los resultados preliminares indican que hay un aumento en las proporciones de carbonatos, yesos y halita desde QS-2 hacia QS-4 y QS-5 (1,07–0,99 Ma), lo que sugiere una progresiva disminución de las precipitaciones en el sureste peninsular hace un millón de años. Los datos son consistentes con el inicio de una fase glaciar, lo cual viene apoyado por la desaparición progresiva en Quibas-Sima de taxones afines a bosques y cursos de agua estables como la ardilla voladora Hylopetes sp. y el musgaño Neomys sp., en favor de la aparición de taxones ligados a espacios abiertos como la culebra bastarda (Malpolon monspessulanus) y la víbora hocicuda (Vipera latastei)

Colorectal cancer in the elderly patient: The role of neo-adjuvant therapy

Neoadjuvant chemoradiotherapy has a significant role in downstaging cancer. It improves the local control of the disease and can make conservative resection of rectal cancer possible. We enrolled 114 patients with subperitoneal rectal cancer who underwent neoadjuvant chemoradio-therapy and radical excision with total mesorectal excision (TME). The primary endpoint was oncological outcomes and the secondary endpoint was surgical outcomes.We evaluate the experience of a multidisciplinary team and the role of neoadjuvant chemoradiotherapy in integrated treatment of cancer of the subperitoneal rectum. Surgical procedures performed were abdominal perineal resection in 4 cases (3.5%), anterior resection in 89 cases (78%), Hartmann's procedure in 5 cases (4.4%), and ultralow resection with coloanal anastomosis and diverting stoma in 16 patients (14%). Local recurrence occurred in 6 patients (5.2%), the overall survival was 71.9% at 5 years and disease-free survival was about 60%. The effect of pathological downstaging amounted to 58.8%, including cPR. The pathologic complete remission occurred in 8.8% of cases. The outcomes of neoadjuvant therapy can be achieved when this treatment is associated with correct surgical technique with TME and the prognosis is defined by an anatomopathological examination performed according to Quirke's protocol